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Plant-based dietary patterns and the risk of digestive system cancers in 3 large prospective cohort studies

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Abstract

Little is known about the relation between plant-based dietary patterns and digestive system cancers. This study investigated the prospective association between 3 pre-defined indices of plant-based dietary pattern and risk of digestive system cancers, as a whole or individually. We utilized data from 3 prospective cohorts, the Nurses’ Health Study (1984–2018, 74,496 women aged 65 ± 10.9 years), Nurses’ Health Study II (1991–2017, 91,705 women aged 49.3 ± 8.3 years), and Health Professionals Follow up Study (1986–2016, 45,472 men aged 65.4 ± 11.0 years). We used Cox proportional hazards regression models to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) of digestive system cancers across 3 plant-based diet index scores: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 4,914,985 person-years, we identified 6,518 cases of digestive system cancers. In the pooled analysis of 3 cohorts, the HRs (95% CIs) per 10-point increase in hPDI score were 0.93 (0.89, 0.97) for total digestive system cancer, 0.94 (0.89, 0.99) for gastrointestinal tract cancer, 0.89 (0.81, 0.98) for accessory organ cancer, and 0.68 (0.52, 0.91) for liver cancer. In contrast, the HRs (95% CIs) per 10-point increase in uPDI score was 1.06 (1.01, 1.11) for gastrointestinal tract cancer and 1.07 (1.01, 1.13) for colorectal cancer. A healthy plant-based dietary pattern was associated with reduced risks of total digestive system cancers as well as individual cancers in the gastrointestinal tract and the accessory organs. Emphasizing the healthiness and quality of plant-based diets may be important for the prevention of developing cancers in the digestive system.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

HR:

Hazard ratio

hPDI:

Healthful plant-based diet index

HPFS:

Health professional follow up study

MET:

Metabolic equivalent of task

NSAID:

Nonsteroidal anti-inflammatory drug

NHS:

Nurses’ health study

PDI:

Overall plant-based diet index

FFQ:

Food frequency questionnaire

uPDI:

Unhealthful plant-based diet index

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Acknowledgements

The authors would like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) and/or the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Central registries may also be supported by state agencies, universities, and cancer centers. Participating central cancer registries include the following: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Seattle SEER Registry, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (Grant Number 2021R1A2C1003211 to Dr. Jihye Kim) and the National Institutes of Health (NIH) (Grant Numbers UM1 CA186107, P01 CA87969, U01 CA176726, and U01 CA167552). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

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  1. Jihye Kim and Jaewon Khil have equally contributed as co-first authors.

Authors and Affiliations

  1. Department of Genetics and Biotechnology, College of Life Science, Kyung Hee University, 1732 Deogyeong-daero, Giheung-Gu, Yongin, Gyeonggi-Do, 17104, Republic of Korea

    Jihye Kim

  2. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Jihye Kim, Jaewon Khil, NaNa Keum, Xuehong Zhang & Edward Giovannucci

  3. Department of Food Science and Biotechnology, Dongguk University Graduate School, Seoul, Republic of Korea

    Jaewon Khil & NaNa Keum

  4. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Hanseul Kim

  5. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Hanseul Kim

  6. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Hanseul Kim

  7. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Xuehong Zhang

  8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Edward Giovannucci

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Drs. JHK (Jihye Kim) and Giovannucci had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JHK and Giovannucci conceived and designed the study. Statistical analysis was done by JHK and Khil and writing manuscript was done by JHK. All authors are involved in critical revision of manuscript. Funding was obtained by JHK. All authors had reviewed and approved the final manuscript.

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Correspondence to Jihye Kim.

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The studies have been approved by the Institutional Review Boards of the Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health and those of participating registries as required.

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Kim, J., Khil, J., Kim, H. et al. Plant-based dietary patterns and the risk of digestive system cancers in 3 large prospective cohort studies. Eur J Epidemiol 38, 617–627 (2023). https://doi.org/10.1007/s10654-023-01007-2

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